Бессимптомная бактериурия у беременных: всегда ли оправдана антибиотикотерапия?

Abstract

Introduction. Asymptomatic bacteriuria (ABU) occurs in 2–15% of pregnant women, but opinions about ABU in pregnant women are controversial. The aim of the study was to assess the outcomes of delivery in pregnant women with ABU, depending on the therapy and urological history. Material and methods. The histories of childbirth of 46 women with ABU detected during prenatal screening, were analyzed. The outcomes of pregnancies were analyzed, and the relationship between the presence of ABU, the type of therapy, the presence of pyelonephritis in history and the development (exacerbation) of pyelonephritis during pregnancy was determined. Results. The structure of uropathogens was typical: E. coli was found in 36 cases (78.3%), Enterococcus faecalis - in 10 cases (21.7%). Seven women (15.2%) had a history of chronic pyelonephritis, 4 (8.7%) had chronic cystitis. The remaining 35 pregnant women (76.1%) had no any urological diseases. More than half of pregnant women with ABU (32/69.6%) received Сanephron; all of them had normal delivery. The average weight of newborns was 3768±101.9 grams. The rest of the 14 (30.4%) pregnant women with ABU, including 7 patients with a history of pyelonephritis, received amoxicillin with clavulonic acid. In more than half of the them (4/57.1%) gestational pyelonephritis developed. Correlational analysis showed that the low weight of the newborn, the development of gestational pyelonephritis and the likelihood of preterm birth did not depend on the therapy for ABU (antibacterial or herbal medicine), but on the presence of chronic pyelonephritis in the pregnant woman. Conclusion. The detection of ABU in a healthy pregnant woman without urological history is not a convincing basis for prescribing antibiotics. Preventive phytotherapy with the drug «Canephron» in such women was sufficient; none of the cases developed gestational pyelonephritis or preterm labor